Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods

2001 ◽  
Vol 94 (1) ◽  
pp. 1-6 ◽  
Author(s):  
John C. Flickinger ◽  
Douglas Kondziolka ◽  
Ajay Niranjan ◽  
L. Dade Lunsford
Keyword(s):  
Acoustic Neuroma ◽  
Gamma Knife Radiosurgery ◽  
Current Treatment ◽  
High Rate ◽  
Tumor Control ◽  
Hearing Level ◽  
Speech Discrimination ◽  
Facial Weakness ◽  
Content Type ◽  
Fine Print

Object. The goal of this study was to define tumor control and complications of radiosurgery encountered using current treatment methods for the initial management of patients with unilateral acoustic neuroma. Methods. One hundred ninety patients with previously untreated unilateral acoustic neuromas (vestibular schwannomas) underwent gamma knife radiosurgery between 1992 and 1997. The median follow-up period in these patients was 30 months (maximum 85 months). The marginal radiation doses were 11 to 18 Gy (median 13 Gy), the maximum doses were 22 to 36 Gy (median 26 Gy), and the treatment volumes were 0.1 to 33 cm3 (median 2.7 cm3). The actuarial 5-year clinical tumor-control rate (no requirement for surgical intervention) for the entire series was 97.1 ± 1.9%. Five-year actuarial rates for any new facial weakness, facial numbness, hearing-level preservation, and preservation of testable speech discrimination were 1.1 ± 0.8%, 2.6 ± 1.2%, 71 ± 4.7%, and 91 ± 2.6%, respectively. Facial weakness did not develop in any patient who received a marginal dose of less than 15 Gy (163 patients). Hearing levels improved in 10 (7%) of 141 patients who exhibited decreased hearing (Gardner-Robertson Classes II–V) before undergoing radiosurgery. According to multivariate analysis, increasing marginal dose correlated with increased development of facial weakness (p = 0.0342) and decreased preservation of testable speech discrimination (p = 0.0122). Conclusions. Radiosurgery for acoustic neuroma performed using current procedures is associated with a continued high rate of tumor control and lower rates of posttreatment morbidity than those published in earlier reports.

Gamma knife radiosurgery for craniopharyngiomas

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 47-56 ◽  
Author(s):  
Wen-Yuh Chung ◽  
David Hung-Chi Pan ◽  
Cheng-Ying Shiau ◽  
Wan-Yuo Guo ◽  
Ling-Wei Wang
Keyword(s):  
Clinical Outcome ◽  
Gamma Knife ◽  
Tumor Volume ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Content Type ◽  
Stereotactic Aspiration ◽  
Cystic Component ◽  
The Mean ◽  
Fine Print

Object. The goal of this study was to elucidate the role of gamma knife radiosurgery (GKS) and adjuvant stereotactic procedures by assessing the outcome of 31 consecutive patients harboring craniopharyngiomas treated between March 1993 and December 1999. Methods. There were 31 consecutive patients with craniopharyngiomas: 18 were men and 13 were women. The mean age was 32 years (range 3–69 years). The mean tumor volume was 9 cm3 (range 0.3–28 cm3). The prescription dose to the tumor margin varied from 9.5 to 16 Gy. The visual pathways received 8 Gy or less. Three patients underwent stereotactic aspiration to decompress the cystic component before GKS. The tumor response was classified by percentage reduction of tumor volume as calculated based on magnetic resonance imaging studies. Clinical outcome was evaluated according to improvement and dependence on replacement therapy. An initial postoperative volume increase with enlargement of a cystic component was found in three patients. They were treated by adjuvant stereotactic aspiration and/or Ommaya reservoir implantation. Tumor control was achieved in 87% of patients and 84% had fair to excellent clinical outcome in an average follow-up period of 36 months. Treatment failure due to uncontrolled tumor progression was seen in four patients at 26, 33, 49, and 55 months, respectively, after GKS. Only one patient was found to have a mildly restricted visual field; no additional endocrinological impairment or neurological deterioration could be attributed to the treatment. There was no treatment-related mortality. Conclusions. Multimodality management of patients with craniopharyngiomas seemed to provide a better quality of patient survival and greater long-term tumor control. It is suggested that GKS accompanied by adjuvant stereotactic procedures should be used as an alternative in treating recurrent or residual craniopharyngiomas if further microsurgical excision cannot promise a cure.

Gamma knife radiosurgery for intracranial metastatic melanoma: a 6-year experience

2002 ◽  
Vol 97 ◽  
pp. 494-498 ◽  
Author(s):  
Jorge Gonzalez-martinez ◽  
Laura Hernandez ◽  
Lucia Zamorano ◽  
Andrew Sloan ◽  
Kenneth Levin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Metastatic Melanoma ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Karnofsky Performance Scale ◽  
Content Type ◽  
Significant Difference ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate retrospectively the effectiveness of stereotactic radiosurgery for intracranial metastatic melanoma and to identify prognostic factors related to tumor control and survival that might be helpful in determining appropriate therapy. Methods. Twenty-four patients with intracranial metastases (115 lesions) metastatic from melanoma underwent radiosurgery. In 14 patients (58.3%) whole-brain radiotherapy (WBRT) was performed, and in 12 (50%) chemotherapy was conducted before radiosurgery. The median tumor volume was 4 cm3 (range 1–15 cm3). The mean dose was 16.4 Gy (range 13–20 Gy) prescribed to the 50% isodose at the tumor margin. All cases were categorized according to the Recursive Partitioning Analysis classification for brain metastases. Univariate and multivariate analyses of survival were performed to determine significant prognostic factors affecting survival. The mean survival was 5.5 months after radiosurgery. The analyses revealed no difference in terms of survival between patients who underwent WBRT or chemotherapy and those who did not. A significant difference (p < 0.05) in mean survival was observed between patients receiving immunotherapy or those with a Karnofsky Performance Scale (KPS) score of greater than 90. Conclusions. The treatment with systemic immunotherapy and a KPS score greater than 90 were factors associated with a better prognosis. Radiosurgery for melanoma-related brain metastases appears to be an effective treatment associated with few complications.

Self-assessed quality of life after acoustic neuroma surgery

2003 ◽  
Vol 99 (5) ◽  
pp. 818-823 ◽  
Author(s):  
Simone A. Betchen ◽  
Jane Walsh ◽  
Kalmon D. Post
Keyword(s):  
Quality Of Life ◽  
Acoustic Neuroma ◽  
Hearing Level ◽  
Content Type ◽  
Sf 36 ◽  
Acoustic Neuroma Surgery ◽  
Persistent Headache ◽  
Facial Function ◽  
Fine Print

Object. The aim of this study was to determine if factors such as postoperative hearing, facial function, headaches, or other factors have an impact on self-assessed quality of life (QOL) after acoustic neuroma surgery. Methods. The SF-36 and seven additional questions on the impact of surgery on the QOL were sent to 135 consecutive patients who had undergone acoustic neuroma surgery. The Spearman rho correlations were calculated for each of the eight categories of the SF-36 (general health, physical functioning, physical role limitations, emotional role limitations, mental health, energy/vitality, pain, social functioning). The results were correlated with patients' sex, age, persistent headache, years since surgery, postoperative hearing level, and facial function. The response rate was 74.8%. The transformed scores of the eight categories of the SF-36 were lower than age-matched healthy controls in approximately half of the categories. The strongest trend toward lower scores with statistical significance in two categories was persistent headaches. Some categories demonstrated trends toward lower scores with females or age older than 55 years. Postoperative hearing and facial functioning, and time since surgery showed no statistically significant impact on QOL measured by the SF-36. Responses to the additional questions indicate that hearing, facial function, and headache influenced people's feelings about surgery and had an impact on their return to work. Conclusions. The QOL scores are not consistently lower than population normative values compared with different normative studies. The strongest correlation was between the presence of persistent headache and QOL. Other correlations were not consistent in all categories, and few were statistically significant. These trends in some categories do not explain the difference seen between patients after acoustic neuroma surgery in this study and normal populations in other studies.

Gamma knife radiosurgery for brain metastases: a primary therapeutic option

2002 ◽  
Vol 97 ◽  
pp. 515-524 ◽  
Author(s):  
Massimo Gerosa ◽  
Antonio Nicolato ◽  
Roberto Foroni ◽  
Bruno Zanotti ◽  
Laura Tomazzoli ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Brain Metastases ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Functional Independence ◽  
Primary Treatment ◽  
Tumor Control ◽  
Content Type ◽  
Cystic Tumors ◽  
Fine Print

Object. The aim of this retrospective study was to assess the role of gamma knife radiosurgery (GKS) as a primary treatment for brain metastases by evaluating the results in particularly difficult cases such as oncotypes—which are unresponsive to radiation—cystic lesions, and highly critical locations such as the brainstem. Methods. Treatment of 804 patients with 1307 solitary (29%), single (26%), and multiple (45%) brain metastases was evaluated. Treatment planning parameters were as follows: mean tumor volume 4.8 cm3 (range 0.01–21.5 cm3), mean prescription dose 20.6 Gy (range 12–29 Gy), and mean number of isocenters 6.5 (one–19). In unresponsive oncotypes such as melanoma and renal cell carcinoma, the mean target dosages were higher. Cystic metastatic lesions were initially stereotactically evacuated and then GKS was performed. Patients with brainstem metastases were treated with lower doses. Conventional radiotherapy was used in only a minority (14%) of selected cases. The overall median patient survival time was 13.5 months, and the 1-year actuarial local progression-free survival rate was 94%, with a mean palliation index and functional independence index of 53.8 and 52.5 weeks, respectively. The local tumor control rate was 93%, with a mean follow-up period of 14 months. In the overall series, and especially in the unresponsive oncotypes, systemic disease progression was the main limiting factor with regard to patient life expectancy. Conclusions. Gamma knife radiosurgery seems to be the primary treatment option for patients harboring small-tomedium size (≤ 20-cm3) brain metastases with reasonable life expectancy and no impending intracranial hypertension. Results are better than with those obtained using whole-brain radiotherapy and comparable to the best selected surgery—radiation series, even in oncotypes unresponsive to therapeutic radiation, cystic tumors, and tumors located in the brain stem.

Vasoactive treatment for hearing preservation in acoustic neuroma surgery

2001 ◽  
Vol 95 (5) ◽  
pp. 771-777 ◽  
Author(s):  
Christian Strauss ◽  
Barbara Bischoff ◽  
Mandana Neu ◽  
Michael Berg ◽  
Rudolf Fahlbusch ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Acoustic Neuroma ◽  
Auditory Evoked Potentials ◽  
Consecutive Series ◽  
Hearing Level ◽  
Pathophysiological Mechanism ◽  
Content Type ◽  
Acoustic Neuromas ◽  
Vasoactive Medication ◽  
Fine Print

Object. Delayed hearing loss following surgery for acoustic neuroma indicates anatomical and functional preservation of the cochlear nerve and implies that a pathophysiological mechanism is initiated during surgery and continues thereafter. Intraoperative brainstem auditory evoked potentials (BAEPs) typically demonstrate gradual reversible loss of components in these patients. Methods. Based on this BAEP pattern, a consecutive series of 41 patients with unilateral acoustic neuromas was recruited into a prospective randomized study to investigate hearing outcomes following the natural postoperative course and recuperation after vasoactive medication. Both groups were comparable in patient age, tumor size, and preoperative hearing level. Twenty patients did not receive postoperative medical treatment. In 70% of these patients anacusis was documented and in 30% hearing was preserved. Twenty-one patients were treated with hydroxyethyl starch and nimodipine for an average of 9 days. In 66.6% of these patients hearing was preserved and in 33.3% anacusis occurred. Conclusions. These results are statistically significant (p < 0.05, χ2 = 5.51) and provide evidence that these surgically treated patients suffer from a disturbed microcirculation that causes delayed hearing loss following removal of acoustic neuromas.

Radiosurgery for residual or recurrent nonfunctioning pituitary adenoma

2002 ◽  
Vol 97 ◽  
pp. 408-414 ◽  
Author(s):  
Jason P. Sheehan ◽  
Douglas Kondziolka ◽  
John Flickinger ◽  
L. Dade Lunsford
Keyword(s):  
Gamma Knife ◽  
Cavernous Sinus ◽  
Pituitary Adenomas ◽  
Visual Fields ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Content Type ◽  
Cavernous Sinus Invasion ◽  
Nonfunctioning Pituitary Adenomas ◽  
Fine Print

Object. Nonfunctioning pituitary adenomas comprise approximately 30% of all pituitary tumors. The purpose of this retrospective study is to evaluate the efficacy and role of gamma knife radiosurgery (GKS) in the management of residual or recurrent nonfunctioning pituitary adenomas. Methods. A review was conducted of the data obtained in 42 patients who underwent adjuvant GKS at the University of Pittsburgh between 1987 and 2001. Prior treatments included transsphenoidal resection, craniotomy and resection, or conventional radiotherapy. Endocrinological, ophthalmological, and radiological responses were evaluated. The duration of follow-up review varied from 6 to 102 months (mean 31.2 months). Fifteen patients were observed for more than 40 months. The mean radiation dose to the tumor margin was 16 Gy. Conformal radiosurgery planning was used to restrict the dose to the optic nerve and chiasm. Tumor control after GKS was achieved in 100% of patients with microadenomas and 97% of patients with macroadenomas. Gamma knife radiosurgery was equally effective in controlling adenomas with cavernous sinus invasion and suprasellar extension. No patient developed a new endocrinological deficiency following GKS. One patient's tumor enlarged with an associated decline in visual function. Another patient experienced a deterioration of visual fields despite a decrease in tumor size. Conclusions. Gamma knife radiosurgery can achieve tumor control in virtually all residual or recurrent nonfunctioning pituitary adenomas. Dose sparing facilitates tumor management even when the adenoma is close to the optic apparatus or invades the cavernous sinus.

Hearing preservation in acoustic neuroma surgery: importance of adhesion between the cochlear nerve and the tumor

2002 ◽  
Vol 97 (2) ◽  
pp. 337-340 ◽  
Author(s):  
Takuzou Moriyama ◽  
Takanori Fukushima ◽  
Katsuyuki Asaoka ◽  
Pierre-Hugues Roche ◽  
David M. Barrs ◽  
...  
Keyword(s):  
Acoustic Neuroma ◽  
Hearing Preservation ◽  
Cochlear Nerve ◽  
Significant Prognostic Factor ◽  
Speech Discrimination ◽  
Middle Fossa ◽  
Content Type ◽  
Middle Fossa Approach ◽  
Acoustic Neuromas ◽  
Fine Print

Object. To evaluate the possible prognostic factors for hearing preservation, the authors retrospectively reviewed the results of 30 consecutive acoustic neuroma operations in which hearing preservation was attempted, in a total series of 63 acoustic neuromas. Methods. Intracanalicular tumors or those that extended less than 3 mm outside the porus acusticus (10 cases) were resected via the middle fossa approach. The retrosigmoid approach was used for tumors exceeding the limits for the middle fossa approach (20 cases). Overall, hearing was preserved (pure tone average ≤ 50 dB and speech discrimination score ≥ 50%) in 21 patients (70%). There were 11 patients with severe adhesion between the cochlear nerve and tumor capsule, and 19 without. Hearing was preserved postoperatively in only two (18.2%) of 11 patients with severe adhesion, whereas all 19 without severe adhesion had hearing preservation. Conclusions. The presence or absence of severe adhesion in the interface between the cochlear nerve and the tumor might be the most significant prognostic factor for hearing preservation postsurgery.

Analysis of treatment outcome after stereotactic radiosurgery for cavernous sinus meningiomas

2001 ◽  
Vol 95 (3) ◽  
pp. 435-439 ◽  
Author(s):  
Masahiro Shin ◽  
Hiroki Kurita ◽  
Tomio Sasaki ◽  
Shunsuke Kawamoto ◽  
Masao Tago ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cavernous Sinus ◽  
Univariate Analysis ◽  
Gamma Knife Radiosurgery ◽  
Tumor Control ◽  
Long Term Outcome ◽  
Content Type ◽  
Fine Print

Object. The long-term outcome of stereotactic radiosurgery for cavernous sinus (CS) meningiomas is not fully understood. The authors retrospectively reviewed their experience with 40 CS meningiomas treated with gamma knife radiosurgery. Methods. Follow-up periods for the 40 patients ranged from 12 to 123 months (median 42 months), and the overall tumor control rates were 86.4% at 3 years and 82.3% at 10 years. Factors associated with tumor recurrence in univariate analysis were histological malignancy (p < 0.0001), partial treatment (p < 0.0001), suprasellar tumor extension (p = 0.0201), or extension in more than three directions outside the CS (p = 0.0345). When the tumor was completely covered with a dose to the margin that was higher than 14 Gy (Group A, 22 patients), no patient showed recurrence within the median follow-up period of 37 months. On the other hand, when a part of the tumor was treated with 10 to 12 Gy (Group B, 15 patients) or did not receive radiation therapy (Group C, three patients), the recurrence rates were 20% and 100%, respectively. Neurological deterioration was seen in nine patients, but all symptoms were transient or very mild. Conclusions. The data indicate that stereotactic radiosurgery can control tumor growth if the whole mass can be irradiated by dosages of more than 14 Gy. When optimal radiosurgical planning is not feasible because of a tumor's large size, irregular shape, or proximity to visual pathways, use of limited surgical resection before radiosurgery is the best option and should provide sufficient long-term tumor control with minimal complications.

Immediate neurological deterioration after gamma knife radiosurgery for acoustic neuroma

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 78-81 ◽  
Author(s):  
Masao Tago ◽  
Atsuro Terahara ◽  
Keiichi Nakagawa ◽  
Yukimasa Aoki ◽  
Kuni Ohtomo ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Gamma Knife ◽  
Acoustic Neuroma ◽  
Gamma Knife Radiosurgery ◽  
Neurofibromatosis Type ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Content Type ◽  
Acoustic Tumor ◽  
Fine Print

✓ The authors describe acute deterioration in facial and acoustic neuropathies following radiosurgery for acoustic neuromas. In May 1995, a 26-year-old man, who had no evidence of neurofibromatosis Type 2, was treated with gamma knife radiosurgery (GKS; maximum dose 20 Gy and margin dose 14 Gy) for a right-sided intracanalicular acoustic tumor. Two days after the treatment, he developed headache, vomiting, right-sided facial weakness, tinnitus, and right hearing loss. There was a deterioration of facial nerve function and hearing function from pretreatment values. The facial function worsened from House—Brackmann Grade 1 to 3. Hearing deteriorated from Grade 1 to 5. Magnetic resonance (MR) images, obtained at the same time revealed an obvious decrease in contrast enhancement of the tumor without any change in tumor size or peritumoral edema. Facial nerve function improved gradually and increased to House—Brackmann Grade 2 by 8 months post-GKS. The tumor has been unchanged in size for 5 years, and facial nerve function has also been maintained at Grade 2 with unchanged deafness. This is the first detailed report of immediate facial neuropathy after GKS for acoustic neuroma and MR imaging revealing early possibly toxic changes. Potential explanations for this phenomenon are presented.

Surgery and radiotherapy compared with gamma knife radiosurgery in the treatment of solitary single cerebral metastases of small diameter

1999 ◽  
Vol 91 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Alexander Muacevic ◽  
Friedrich W. Kreth ◽  
Gerhard A. Horstmann ◽  
Robert Schmid-Elsaesser ◽  
Berndt Wowra ◽  
...  
Keyword(s):  
Survival Time ◽  
Gamma Knife Radiosurgery ◽  
Local Tumor Control ◽  
Cerebral Metastases ◽  
Tumor Control ◽  
Local Tumor ◽  
Treatment Results ◽  
Death Rates ◽  
Content Type ◽  
Fine Print

Object. The aim of this retrospective study was to compare treatment results of surgery plus whole-brain radiation therapy (WBRT) with gamma knife radiosurgery alone as the primary treatment for solitary cerebral metastases suitable for radiosurgical treatment.Methods. Patients who had a single circumscribed tumor that was 3.5 cm or smaller in diameter were included. Treatment results were compared between microsurgery plus WBRT (52 patients, median tumor dose 50 Gy) and radiosurgery alone (56 patients, median prescribed tumor dose 22 Gy). In case of local/distant tumor recurrence in the radiosurgery group, additional radiosurgical treatment was administered in patients with stable systemic disease. Survival time was analyzed using the Kaplan—Meier method, and prognostic factors were obtained from the Cox model. The patient groups did not differ in terms of age, gender, pretreatment Karnofsky Performance Scale (KPS) score, duration of symptoms, tumor location, histological findings, status of the primary tumor, time to metastasis, and cause of death. Patients who suffered from larger lesions underwent surgery (p < 0.01). The 1-year survival rate (median survival) was 53% (68 weeks) in the surgical group and 43% (35 weeks) in the radiosurgical group (p = 0.19). The 1-year local tumor control rates after surgery and radiosurgery were 75% and 83%, respectively (p = 0.49), and the 1-year neurological death rates in these groups were 37% and 39% (p = 0.8). Shorter overall survival time in the radiosurgery group was related to higher systemic death rates. A pretreatment KPS score of less than 70 was a predictor of unfavorable survival. Perioperative morbidity and mortality rates were 7.7% and 1.6% in the resection group, and 8.9% and 1.2% in the radiosurgery group, respectively. Four patients presented with transient radiogenic complications after radiosurgery.Conclusions. Radiosurgery alone can result in local tumor control rates as good as those for surgery plus WBRT in selected patients. Radiosurgery should not be routinely combined with radiotherapy.

Sign in / Sign up

Export Citation Format

Share Document